Exposure to cytotoxics: a wide scale measurement campaign in a hospital

Marie Robert1, Eva Coulpier1, Elisabeth Lheritier1.
1 Centre Hospitalier de Dieppe, Pharmacie, Avenue Pasteur, 76202 Dieppe. France

Introduction
Chemical contamination by anticancer drugs (AD) has been the subject of numerous publications but studies on the entire circuit from reception to administration remain few.

Objectives
To confirm and locate the presence of cytotoxics in our institution, where 6000 preparations are administered per year in oncology day hospital (ODH).

Material and methods
After obtaining funding from the management and the agreement of the Health, Safety and Working Conditions Committee, a large sampling campaign was carried out at all stages of the circuit. In total, 44 samples were collected: 25 in the care departments (4 in Pneumology, 4 in Internal Medicine and 17 in ODH) and 19 in the pharmacy/production unit. The points to be sampled were surfaces likely to be contaminated, defined in collaboration with the team of an expert university hospital, to whom the processing of the samples had been assigned.

Results
In total, 16 out of 44 samples (36%) are positive. In the pharmacy, 4/19 samples (21%) are positive: vials (1/1), isolator outlet (1/1) and bags (2/4). The other sampling points in the unit are negative (storage drawer, benches, wastebasket, etc.). In the care units (care station/individual rooms): 12/25 are positive: patient toilets (4/5), infusion stand (1/1), armchairs (4/5), bag (1/1), patient table (1/5) and staff’s adaptable table (1/5). Other negatives include: infusion pump (1/1), bag storage cart (1/1) and remote control (1/1). In the treatment room, where 2 items are tested before and after cleaning, one is negative. In addition, 5 samples are positive for an AD that is not included in the patient care protocol.

Discussion
The analysis of the results demonstrates the presence of cytotoxics at all stages of the circuit. The majority of positive samples are located in the care units. Contamination is sometimes distant from the infusion site (toilets or accommodation services). Finding AD which are not administered to the patient shows the persistence of traces. Administration is a step at risk of occupational exposure for various reasons: trivialization of AD administration, exposure during disconnections, management of patient excreta, inadequate facility cleaning. The results have been shared with all concerned staff members in order to reinforce individual protection measures gloves wearing and frequency of change - and to ensure efficient facility cleaning. In the production unit, corrective actions have been implemented such as the systematic cleaning of the bags with a detergent, at the exit of the isolator. The new sampling campaign planned will ensure that this risk is better controlled.

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